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Laparoscopic Total Mesorectal Excision Based on 100 Cases

A. Filipov, M. Tabakov, B. Benishev, I. Ivanov, D. Andonov


Introduction: Laparoscopic rectal resection is a widely adopted method for surgical treatment of rectal cancer. The patients treated by laparoscopy benefit from the general advantages of the minimally invasive approach over the open surgery, whereas the long-term oncologic results are comparable. Aim: The purpose of this study is to introduce the 7-year experience of the 4th Surgical Clinic, UHATEM `N.I.Pirogov` with more than 100 laparoscopic rectal resections for cancer.Materials and Methods: From January, 2009 till December, 2015, 104 laparoscopic rectal resections with curative intention were executed. Only patients with cT1-cT3 tumors, without evidence of distant metastases, were included.Results: The study group included 69 (66.34%) men and 35 (33.66%) women, between 34 and 86 years of age, with mean BMI 26kg/m2 (21-32 kg/m2). According to tumor localization from the anal verge, the patients were separated in three groups: proximal rectum (10-15cm) - 34 (32.7%); middle rectum (5<10cm)- 47(45.2%) and distal rectum (<5cm) -23 (22.1%). 36 (56.2%) patients had undergone neoadjuvant radiotherapy. 12 (18.8%) of the operated patients were in pathologic stage I, 23 (35.9%) - stage II, 29 (45.3%) -stage III. Conversion to open procedure was done in 5 cases (3.84%). The mean operative time was 180min. (120 - 420min.) and the mean blood loss was 80ml (20-800ml). The bowel function recovered on postoperative day 2 (1-7). The mean hospital stay was 5 days (3-17). Complications occurred in 8 patients (5.12%). The laparoscopically treated patients were followed up for an average of 24 months (3-36). The general cancer recurrence rate was 15.6%.Conclusion: The laparoscopic rectal resections for rectal cancer are safe procedures that outweigh the open interventions with less postoperative pain, less blood loss, faster recovery of bowel function, shorter hospital stay and excellent cosmetic effect, by similar long-term oncologic results.


Keywords: Laparoscopy, TME, Rectal carcinoma



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About The Authors

A. Filipov

M. Tabakov

B. Benishev

I. Ivanov

D. Andonov

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